Impacto del 18F-FDG PET/TC en el abordaje terapéutico del cáncer de pulmón no microcítico |
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Authors: | Á lvaro Taus,Rafael Aguiló ,Ví ctor Curull,Marina Suá rez-Piñ era,Alberto Rodrí guez-Fuster,Nuria Rodrí guez de Dios,Lara Pijuan,Flavio Zuccarino,Ivá n Vollmer,Albert Sá nchez-Font,José Belda-Sanchis,Edurne Arriola |
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Affiliation: | 1. Departamento de Oncología Médica, Hospital del Mar-Parc de Salut Mar, Barcelona, España;2. Departamento de Cirugía Torácica, Hospital del Mar-Parc de Salut Mar, Barcelona, España;3. Departamento de Neumología, Hospital del Mar-Parc de Salut Mar, Universitat Autònoma de Barcelona, Universitat Pompeu Fabra, CIBER de Enfermedades Respiratorias, Barcelona, España;4. Departamento de Medicina Nuclear, Hospital del Mar-Parc de Salut Mar, Barcelona, España;5. Departamento de Radioterapia, Hospital de la Esperança-Parc de Salut Mar, Barcelona, España;6. Departamento de Anatomía Patológica, Hospital de la Esperança-Parc de Salut Mar, Barcelona, España;g Departamento de Radiología, Hospital del Mar-Parc de Salut Mar, Barcelona, España |
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Abstract: | IntroductionDisease stage is the most important prognostic factor in lung cancer, and optimal staging is important to determine the best therapeutic option. FDG-PET/CT has demonstrated its value in early stage non-small cell lung cancer (NSCLC) but there is still insufficient data to define its role in other stages.HypothesisInformation provided by FDG-PET/CT has an impact on the therapeutic management of patients with NSCLC.MethodsA retrospective review was made of patients who underwent FDG-PET/CT between January 2008 and December 2010 for the diagnosis of NSCLC. Clinical stage before and after FDG-PET/CT and information about any change in therapeutic decision due to information provided by FDG-PET/CT were collected. Using pathologic evaluation as the gold standard, sensitivity, specificity, and positive and negative predictive values for CT and FDG-PET/CT were calculated.ResultsOf the 522 patients diagnosed of NSCLC, FDG-PET/CT was performed in 246 (47.1%). In 85 cases (34.6%) FDG-PET/CT led to stage migration. Treatment was modified in 60 patients (24.4% of all FDG-PET/CT performed), avoiding a futile thoracotomy in 13 cases (5.2%), and allowing treatment with curative intent in 26 (10.5%). Out of 90 patients (36.5%) evaluated as stage iii by CT staging, FDG-PET/CT modified the therapeutic approach in 36 (40%). For the 133 cases (54%) with pathological assessment of the mediastinal lymph nodes, sensitivity, specificity, positive predictive value and negative predictive value were 0.57, 0.64, 0.48 and 0.72 for CT, and 0.68, 0.86, 0.75 and 0.81 for FDG-PET/CT.DiscussionOur data support previous reports that FDG-PET/CT is essential in the staging process not only for patients with potentially operable NSCLC but also for stage iii patients, as demonstrated by our data. |
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Keywords: | Cá ncer de pulmó n no microcí tico FDG PET/TC Tomografí a computarizada Estadificació n |
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